Ambulance services a financial drain on fire district

DAYTON - Without changes in federal guidelines, ambulance services will continue to be a financial drain on the Central Lyon County Fire District.

The district lost $252,123 in uncollected ambulance fees in fiscal year 1998-99. According to District Chief Bill Driscoll, about 40 percent of all bills generated from ambulance service calls go uncollected, with costs ultimately falling on district taxpayers.

"We budgeted $183,000 in this year's budget to cover losses, but we will surpass that. Our volume of calls is up over last year. As the call volume increases, the bad debt goes up," Driscoll said.

And unless Medicare changes reimbursement rates for the district, the collection rate will remain the poorest of area fire districts.

Central Lyon County Fire District billing is done through a billing cooperative that includes Carson City, North Lake Tahoe and Douglas/Tahoe Fire Districts. All invoices are generated through the Carson City Emergency Medical Services Division, under the supervision of EMS Chief Vince Pirozzi.

When payment is not received, unpaid bills are turned over to a collection agency. The collection agency retains 30 percent of any collected debts, the fire district receives the remaining 70 percent.

Medicare pays a flat reimbursement rate per patient to each district.

According to Pirozzi, the collection rate in the Central Lyon district is much worse than the approximately 70 percent success rate of the other districts. The problem lies in the disparity of reimbursement rates.

"Carson City receives an 85 percent reimbursement of costs from Medicare. Lyon County receives only 15 percent for the same services and trip, which is actually longer," Pirozzi said. "Medicare sets the rates. Central Lyon has been trying for years to find out why they are treated differently, but finding an answer has been impossible."

According to Pirozzi, about half of central Lyon County patients are on the Medicare program. With unpaid portions of a Medicare bill required to be written off, the return rate is much lower.

"It is federal law that when you provide ambulance services you must accept Medicare patients. You can't opt out. Central Lyon is locked into it and (the collection problem) won't be solved unless they get Medicare to change its reimbursement rates," Pirozzi explained.

With the Medicare reimbursement rate so low, collecting from the remaining patients becomes increasingly important to district officials.

However, Jim Allender, assistant volunteer chief in Silver City, expressed concern with the ability of some residents to pay and cautioned restraint.

"We are not in a very rich county. Many are not prepared for an emergency," Allender told the board. "We have to have a little compassion when we look at individual medical bills."

It is those who make no effort to pay off their bad debts that concern the district most.

"We do have people willing to try and pay, at $10 a month, or whatever they can afford," board member Richard Forant said, "but when they simply thumb their noses at us, that is different. We are willing to work with them."

In support of a forceful collection policy, Forant said, "Some people don't care if their credit gets all tore up. They do care if we go after their paycheck."

The district has a prepaid ambulance plan that eliminates any out-of-pocket expenses for residents, even for those with no insurance coverage. A $50 prepaid fee insures a family will be covered for any unexpected ambulance trips for a year.

Driscoll doesn't think the program has a significant effect on reducing the number of unpaid bills, however.

"The people who buy into the "Frontier Saver" (ambulance program) are generally the ones who pay their bills.

Looking for answers to improving their billing success, Driscoll was directed to ask Pirozzi and a collection agency official to attend the next board meeting.